Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

Martina Rojnic Kuzman; Merete Nordentoft; Andrea Raballo; Pavel Mohr; Andrea Fiorillo; Geert Dom; Goran Mihajlovic; Tihana Jendricko; Egor Chumakov; Stojan Barjaktarov; Bernardo Carpiniello; Michal Patarák; Lorcan Martin; Dominika Dudek; Jerzy Samochowiec; Māris Taube; Philippe Courtet; Dragan Babic; Goran Racetovic; Kirsten Catthoor; Celso Arango; Nataliya Maruta; Koray Basar; Simavi Vahip; György Szekeres; Lars Lien; Ana Popova; Ruslan Zhelev; Erika Jääskeläinen; Mirjana Delic; Eka Chkonia; Jana Chichai; Diogo Telles-Correia; Doina Constanta Maria Cosman; Julian Beezhold; Peter Falkai

doi:10.1192/j.eurpsy.2025.10072

Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

Martina Rojnic Kuzman, Merete Nordentoft, Andrea Raballo, Pavel Mohr, Andrea Fiorillo, Geert Dom, Goran Mihajlovic, Tihana Jendricko, Egor Chumakov, Stojan Barjaktarov, Bernardo Carpiniello, Michal Patarák, Lorcan Martin, Dominika Dudek, Jerzy Samochowiec, Māris Taube, Philippe Courtet, Dragan Babic, Goran Racetovic, Kirsten CatthoorCelso Arango, Nataliya Maruta, Koray Basar, Simavi Vahip, György Szekeres, Lars Lien, Ana Popova, Ruslan Zhelev, Erika Jääskeläinen, Mirjana Delic, Eka Chkonia, Jana Chichai, Diogo Telles-Correia, Doina Constanta Maria Cosman, Julian Beezhold, Peter Falkai

4 Citations (Scopus)

Abstract

BACKGROUND: We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations - the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects - while assessing clinicians' adherence to guidelines.

METHODS: A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A-F). Additionally, a review of multiple guidelines/guidance papers was performed.

RESULTS: The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.

CONCLUSIONS: These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians' unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

Original language	English
Article number	e107
Journal	European psychiatry : the journal of the Association of European Psychiatrists
Volume	68
Issue number	1
ISSN	0924-9338
DOIs	https://doi.org/10.1192/j.eurpsy.2025.10072
Publication status	Published - 1 Aug 2025
Externally published	Yes

Keywords

Humans
Schizophrenia/therapy
Europe
Cross-Sectional Studies
Female
Adult
Practice Guidelines as Topic
Psychiatry/statistics & numerical data
Guideline Adherence/statistics & numerical data
Male
Antipsychotic Agents/therapeutic use
Practice Patterns, Physicians'/statistics & numerical data
Middle Aged
Attitude of Health Personnel
Psychiatrists
psychotherapy
schizophrenia
psychopharmacology
guidelines

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10.1192/j.eurpsy.2025.10072

Cite this

Rojnic Kuzman, M., Nordentoft, M., Raballo, A., Mohr, P., Fiorillo, A., Dom, G., Mihajlovic, G., Jendricko, T., Chumakov, E., Barjaktarov, S., Carpiniello, B., Patarák, M., Martin, L., Dudek, D., Samochowiec, J., Taube, M., Courtet, P., Babic, D., Racetovic, G., ... Falkai, P. (2025). Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective. European psychiatry : the journal of the Association of European Psychiatrists, 68(1), Article e107. https://doi.org/10.1192/j.eurpsy.2025.10072

Rojnic Kuzman, M, Nordentoft, M, Raballo, A, Mohr, P, Fiorillo, A, Dom, G, Mihajlovic, G, Jendricko, T, Chumakov, E, Barjaktarov, S, Carpiniello, B, Patarák, M, Martin, L, Dudek, D, Samochowiec, J, Taube, M, Courtet, P, Babic, D, Racetovic, G, Catthoor, K, Arango, C, Maruta, N, Basar, K, Vahip, S, Szekeres, G, Lien, L, Popova, A, Zhelev, R, Jääskeläinen, E, Delic, M, Chkonia, E, Chichai, J, Telles-Correia, D, Cosman, DCM, Beezhold, J & Falkai, P 2025, 'Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective', European psychiatry : the journal of the Association of European Psychiatrists, vol. 68, no. 1, e107. https://doi.org/10.1192/j.eurpsy.2025.10072

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title = "Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective",

abstract = "BACKGROUND: We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations - the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects - while assessing clinicians' adherence to guidelines.METHODS: A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A-F). Additionally, a review of multiple guidelines/guidance papers was performed.RESULTS: The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.CONCLUSIONS: These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians' unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.",

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author = "\{Rojnic Kuzman\}, Martina and Merete Nordentoft and Andrea Raballo and Pavel Mohr and Andrea Fiorillo and Geert Dom and Goran Mihajlovic and Tihana Jendricko and Egor Chumakov and Stojan Barjaktarov and Bernardo Carpiniello and Michal Patar{\'a}k and Lorcan Martin and Dominika Dudek and Jerzy Samochowiec and Māris Taube and Philippe Courtet and Dragan Babic and Goran Racetovic and Kirsten Catthoor and Celso Arango and Nataliya Maruta and Koray Basar and Simavi Vahip and Gy{\"o}rgy Szekeres and Lars Lien and Ana Popova and Ruslan Zhelev and Erika J{\"a}{\"a}skel{\"a}inen and Mirjana Delic and Eka Chkonia and Jana Chichai and Diogo Telles-Correia and Cosman, \{Doina Constanta Maria\} and Julian Beezhold and Peter Falkai",

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doi = "10.1192/j.eurpsy.2025.10072",

language = "English",

volume = "68",

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TY - JOUR

T1 - Schizophrenia treatment preferences of psychiatrists versus guidelines

T2 - A European perspective

AU - Rojnic Kuzman, Martina

AU - Nordentoft, Merete

AU - Raballo, Andrea

AU - Mohr, Pavel

AU - Fiorillo, Andrea

AU - Dom, Geert

AU - Mihajlovic, Goran

AU - Jendricko, Tihana

AU - Chumakov, Egor

AU - Barjaktarov, Stojan

AU - Carpiniello, Bernardo

AU - Patarák, Michal

AU - Martin, Lorcan

AU - Dudek, Dominika

AU - Samochowiec, Jerzy

AU - Taube, Māris

AU - Courtet, Philippe

AU - Babic, Dragan

AU - Racetovic, Goran

AU - Catthoor, Kirsten

AU - Arango, Celso

AU - Maruta, Nataliya

AU - Basar, Koray

AU - Vahip, Simavi

AU - Szekeres, György

AU - Lien, Lars

AU - Popova, Ana

AU - Zhelev, Ruslan

AU - Jääskeläinen, Erika

AU - Delic, Mirjana

AU - Chkonia, Eka

AU - Chichai, Jana

AU - Telles-Correia, Diogo

AU - Cosman, Doina Constanta Maria

AU - Beezhold, Julian

AU - Falkai, Peter

PY - 2025/8/1

Y1 - 2025/8/1

N2 - BACKGROUND: We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations - the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects - while assessing clinicians' adherence to guidelines.METHODS: A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A-F). Additionally, a review of multiple guidelines/guidance papers was performed.RESULTS: The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.CONCLUSIONS: These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians' unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

AB - BACKGROUND: We aimed to identify therapeutic approaches for managing schizophrenia in different phases and clinical situations - the prodromal phase, first-episode psychosis, cognitive and negative symptoms, pregnancy, treatment resistance, and antipsychotic-induced metabolic side effects - while assessing clinicians' adherence to guidelines.METHODS: A cross-sectional online survey was conducted in 2023 as part of the Ambassador project among psychiatrists and trainees from 35 European countries, based on a questionnaire that included six clinical vignettes (cases A-F). Additionally, a review of multiple guidelines/guidance papers was performed.RESULTS: The final analysis included 454 participants. Our findings revealed a moderate to high level of agreement among European psychiatrists regarding pharmacological treatment preferences for first-episode psychosis and cognitive and negative symptoms, prodromal symptoms and pregnancy, with moderate adherence to clinical guidelines. There was substantial similarity in treatment preferences for antipsychotic-induced metabolic side effects and treatment resistance; however, adherence to guidelines in these areas was only partial. Despite guideline recommendations, non-pharmacological treatments, including psychotherapy and recovery-oriented care, were generally underutilized, except for psychoeducation and lifestyle recommendations, and cognitive behavioural therapy for treatment of the prodromal phase. Contrary to guidelines, cognitive remediation and physical exercise for cognitive symptoms were significantly neglected.CONCLUSIONS: These discrepancies highlight the need for effective implementation strategies to bridge the gap between research evidence, clinical guidelines/guidance papers, and real-world clinical practice. Clinicians' unique combination of knowledge and experience positions them to shape future guidelines, especially where real-world practice diverges from recommendations, reinforcing the need to integrate both research evidence and clinical consensus.

KW - Humans

KW - Schizophrenia/therapy

KW - Europe

KW - Cross-Sectional Studies

KW - Female

KW - Adult

KW - Practice Guidelines as Topic

KW - Psychiatry/statistics & numerical data

KW - Guideline Adherence/statistics & numerical data

KW - Male

KW - Antipsychotic Agents/therapeutic use

KW - Practice Patterns, Physicians'/statistics & numerical data

KW - Middle Aged

KW - Attitude of Health Personnel

KW - Psychiatrists

KW - psychotherapy

KW - schizophrenia

KW - psychopharmacology

KW - guidelines

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U2 - 10.1192/j.eurpsy.2025.10072

DO - 10.1192/j.eurpsy.2025.10072

M3 - Review

C2 - 40745910

SN - 0924-9338

VL - 68

JO - European psychiatry : the journal of the Association of European Psychiatrists

JF - European psychiatry : the journal of the Association of European Psychiatrists

IS - 1

M1 - e107

ER -

Schizophrenia treatment preferences of psychiatrists versus guidelines: A European perspective

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Keywords

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